High Prevelance of Rifampin-Monoresistant Tuberculosis: A Retrospective Analysis among Iranian Pulmonary Tuberculosis Patients

Abstract

Abstract. We determined the prevalence of rifampin-monoresistant tuberculosis (RMR-TB) in Iran. Because development of RMR-TB is not common, we also identified the major risk factors associated with RMR-TB reported from different provinces of Iran. Data for 3,020 TB patients who remained or became smear positive after two, four, six, and nine months of standard first-line chemotherapy were retrospectively analyzed. Of 3,020 patients, 1,242 patients (41.1%) were culture and DNA positive for Mycobacterium tuberculosis. Of these patients, 73 (7.4%) patients had monoresistant isolates to rifampin, which was significantly higher than that for multidrug-resistant TB (5.8%). The average rate of RMR-TB in the studied population ranged from 5% to 10%. Classical investigation showed that 33.6% of patients had either a previous or family history of TB. Molecular epidemiology methods (i.e., spoligotyping and Mycobacterium intespersed repetitive unit-variable number tandem repeat), defined transmission link in three clusters (13%). These results outline the urgent need for a comprehensive plan for detection and treatment of RMR-TB cases.

Rifampin Resistance Mutations Are Associated with Broad Chemical Remodeling of Mycobacterium tuberculosis

“…First-line tuberculosis treatment involves four drugs, the two most effective of which are isoniazid and rifampin. Strains resistant to rifampin alone, although once considered rare, now make up a large percentage of monoresistant M. tuberculosis isolates (3,4). Moreover, resistance to both rifampin and isoniazid constitutes a clinical state of multidrug resistance, which necessitates treatment with a complicated second-line regimen that is both more toxic and less effective than standard chemotherapy (5).…”

Mycobacterium tuberculosis Complex Drug Resistance in a High Tuberculosis Incidence Area from the WHO Eastern Mediterranean Region

“…The National Research Institute of Tuberculosis and Lung Disease of Iran conducted a retrospective analysis for drug resistance patterns among 47 MTB isolates from Golestan province using Multiplex PCR to detect mutations in the genes responsible for RMP and INH resistance from 2010 to 2011 and showed that 4.2% of isolates were MDR (17). This percentage seems to be overestimated because they included TB patients who remained sputum smear positive after two to nine months of standard therapy.…”

Identification and Genotyping of Mycobacterium tuberculosis Isolated From Water and Soil Samples of a Metropolitan City

“…A molecular analysis was performed on single colonies derived from subcultures of original isolates as previously described. 13 …”